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Prostatitis

Prostatitis is a category of disease with many different subtypes, some of which might actually be separate diseases altogether.

Type I: acute bacterial prostatitis

The simplest kind of prostatitis is an acute infection of the prostate. This happens when bacteria or other microorganisms gets inside the urethra and travel up into the ducts and glands of the prostate. It causes a sudden onset of symptoms including pain in the prostate/perineum/lower back, pain and difficulty with urination, plus fever and chills. Most of the time, a complete course of antibiotics resolves the infection. This is called Type I: acute bacterial prostatitis.

Type II: chronic bacterial prostatitis

Sometimes, prostate infections become chronic. Lots of the symptoms are the same, especially frequent and painful urination. But rather than a sudden onset, the symptoms appear gradually and come and go over time. This is most common when a case of Type 1 prostatitis is not fully cured. It can also happen in cases of recurrent urethral infection, or in patients with a history of repeated use of urethral instruments, such as sounds and catheters. This is called Type II: chronic bacterial prostatitis.

While inflammation and bacteria or other microorganisms are found in the prostatic fluid, just like Type I, it’s not yet clear why Type II is not consistently cured by antibiotics. In some cases, multiple rounds of cultures and different types of antibiotics may clear the infection, but when that doesn’t work, the prostate lives in a chronic state of inflammation.

Type III: chronic pelvic pain syndrome

The most commonly diagnosed form of prostatitis is also the hardest to cure- Type III: chronic pelvic pain syndrome. In these cases, the patient experiences the usual pelvic pain and urinary symptoms, and occasionally sexual symptoms such as pain during ejaculation. In some cases, inflammation of the prostate is detected by finding inflammatory products (a nice way of saying “pus”) in the prostatic fluid or urine. In others, signs of inflammation are not found; inflammation may still be present but is not detected. Either way, no bacteria are found, and the cause of symptoms is unclear.

Even though no bacteria (and sometimes no inflammation) is found in these cases, it has historically been diagnosed as a form of prostatitis (“nonbacterial prostatitis”) because the symptoms seemed so similar to those of chronic bacterial prostatitis (Type II).

In 1995, when the National Institutes of Health (NIH) held a convention to redefine the categories of prostatitis. They pointed out that in some cases of prostatitis the cause was unknown and that the prostate might not always be the origin of the symptoms. As a result, the old category of “nonbacterial prostatitis” was replaced by the new category Type III: chronic pelvic pain syndrome (CPPS).

Since prostatitis Types II and III are so similar in their chronic nature and the difficulty of treatment, they are often referred to collectively as CP/CPPS. To the frustration of doctors and patients alike, many men struggle with these conditions on an ongoing basis. This is an active area of research, and many studies are currently under way to fill in the many unknowns.

Some pelvic physical therapists have also pointed out that muscle spasms in some of the pelvic floor muscles can irritate and inflame the prostate. Our colleagues at the Pelvic Health and Rehabilitation Center have had some success in treating CP/CPPS, so if you think you might be experiencing this condition, they might be able to offer some help.

Prostate Massage as a Treatment for Prostatitis?

Although antibiotics can be effective in treating many cases of prostatitis, massage can also be helpful, either on its own or alongside medications. Prostate massage and prostate milking can increase blood flow, release muscular tension affecting the prostate, flush out trapped fluids and clear blockages, and increase your prostate health awareness. While the general consensus in the medical field is that more research is needed, especially since the causes of prostatitis and the reasons for difficulty of cure are not always clear, many men are trying it to see if it helps with their situations.